Infectious Diseases Institute, Kampala, Uganda.
Kawempe National Referral Hospital, Kampala, Uganda.
BMC Womens Health. 2024 Sep 2;24(1):483. doi: 10.1186/s12905-024-03323-5.
More efficient methods to detect and treat precancerous lesions of the cervix at a single visit, such as low-cost confocal microscopy, could improve early diagnosis and hence outcomes. We piloted a prototype smartphone-compatible confocal micro-endoscope (SCME) among women presenting to a public cervical cancer screening clinic in Kampala, Uganda. We describe the piloting of the SCME device at an urban clinic used by lower cadre staff.
We screened women aged 18 and 60 years, who presented for cervical cancer screening at the Kawempe National Referral Hospital Kampala, and evaluated the experience of their providers (nurses). Nurses received a 2-day training by the study doctors on how to use the SCME, which was added to the standard Visual Inspection with Acetic acid (VIA)-based cervical cancer screening. The SCME was used to take colposcopy images before and after VIA at positions 12 and 6 O'clock if VIA negative, and on precancer-suspicious lesions if VIA positive. We used questionnaires to assess the women's experiences after screening, and the experience of the nurses who operated the SCME.
Between November 2021 and July 2022, we screened 291 women with a median age of 36 years and 65.7% were HIV positive. Of the women screened, 146 were eligible for VIA, 123 were screened with the SCME, and we obtained confocal images from 103 women. Of those screened with the SCME, 60% found it comfortable and 81% were willing to screen again with it. Confocal images from 79% of the women showed distinguishable cellular features, while images from the remaining 21% were challenging to analyze. Nurses reported a mean score of 85% regarding the SCME's usefulness to their work, 71% regarding their satisfaction and willingness to use it again, 63% in terms of ease of use, and 57% concerning the ease of learning how to operate the SCME.
Our findings demonstrate the feasibility of using the SCME by lower cadre staff in low-resource settings to aid diagnosis of precancerous lesions. However, more work is needed to make it easier for providers to learn how to operate the SCME and capture high-quality confocal images.
在单次就诊中，更有效的方法来检测和治疗宫颈癌前病变，如低成本的共聚焦显微镜，可以改善早期诊断，从而改善结果。我们在乌干达坎帕拉的一家公共宫颈癌筛查诊所对女性进行了原型智能手机兼容共聚焦微内镜 (SCME) 的试点研究。我们描述了在一个由低级别工作人员使用的城市诊所中对 SCME 设备进行的试点研究。
我们对 18 岁至 60 岁的妇女进行了筛查，这些妇女在坎帕拉的卡温佩国家转诊医院进行了宫颈癌筛查，并评估了他们的提供者（护士）的经验。护士接受了由研究医生提供的为期两天的培训，学习如何使用 SCME，这是在标准的醋酸视觉检查 (VIA) 基础上进行宫颈癌筛查的补充。如果 VIA 阴性，则在 12 点和 6 点位置用 SCME 进行阴道镜检查图像，然后对 VIA 阳性的癌前可疑病变进行阴道镜检查图像。我们使用问卷评估女性筛查后的体验以及操作 SCME 的护士的体验。
在 2021 年 11 月至 2022 年 7 月期间，我们对 291 名年龄中位数为 36 岁且 65.7%为 HIV 阳性的妇女进行了筛查。在接受筛查的妇女中，有 146 名符合 VIA 筛查条件，有 123 名接受了 SCME 筛查，我们从 103 名妇女中获得了共聚焦图像。在接受 SCME 筛查的妇女中，60%的人感到舒适，81%的人愿意再次接受该检查。从 79%的妇女的共聚焦图像中可以看出可分辨的细胞特征，而其余 21%的图像则难以分析。护士对 SCME 对其工作的有用性的评分平均为 85%，对其满意度和再次使用的意愿的评分平均为 71%，对其易用性的评分平均为 63%，对其学习如何操作 SCME 的易用性的评分平均为 57%。
我们的研究结果表明，在资源匮乏的环境中，较低级别的工作人员可以使用 SCME 来辅助诊断癌前病变，这是可行的。然而，还需要更多的工作来使提供者更容易学习如何操作 SCME 并捕获高质量的共聚焦图像。
